Cody A Ezolt, PA-C
Individual provider Active NPI Physician Assistant · Waynesboro, PA
NPI 1154983757 · NPPES record last updated May 12, 2022
Key facts
- NPI
- 1154983757
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- MA060824 (PA)
- Practice address
- 601 E Main St
Waynesboro, PA 17268-2332 - Phone
- (717) 765-5088
- Fax
- (717) 765-5066
- NPI assigned
- Jul 3, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Heritage Valley Multispecialty Group Inc
Practice addresses (Care Compare)
1000 Dutch Ridge Rd
Beaver, PA 15009-9727
Phone (724) 773-6403
500 Sharon Rd
Beaver, PA 15009-1957
Phone (724) 728-8751
93 Boundry LN
Beaver, PA 15009-2949
Phone (724) 773-6400
Hospital & facility affiliations
- Heritage Valley Beaver
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190726000851 | PA | Practitioner - Physician Assistant | 4082940143 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Heritage Valley Multispecialty Group, Inc | Current |
Accepting new patients | |
| Heritage Valley Multispecialty Group, Inc. | Past | Accepting new patients | |
| Heritage Valley Medical Group, Inc. | Past | Accepting new patients |
Locations
1000 Dutch Ridge Rd
Beaver, PA 15009
Phone (724) 728-7000
2 Peartree Way
Beaver, PA 15009
Phone (724) 773-6802
500 Sharon Rd
Beaver, PA 15009
Phone (724) 728-7683
Interoperability endpoints
- codyezolt@hvhs.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | |||
| Physician Assistant | 363A00000X | MA060824 | PA | Yes |
Addresses
Primary practice location
601 E Main St
Waynesboro, PA 17268-2332
Mailing address
785 5TH Ave Ste 3
Chambersburg, PA 17201-4232
Phone (717) 263-9555
Other practice location 1
1000 Norland Ave
Chambersburg, PA 17201-4229
Phone (717) 267-6363
Other practice location 2
46 Walnut Bottom Rd Ste 100
Shippensburg, PA 17257-8219
Phone (717) 477-2764
Other practice location 3
24 Antrim Commons Dr
Greencastle, PA 17225-1623
Phone (717) 597-5553
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 103650235 | Medicaid | PA | |
| 14497750 | Other | CAQH | |
| MA060824 | Other | PA | PA LICENSE |
Other providers in Waynesboro, PA
- Kristan Ellen Eddy-Thorne
- Edward J Yelinek, PC
- Elevation Healthcare
- Ron T Emge
- Justin Erb
- John Edgar Farmer
- Joe Rice Ferguson III
- Robert Kent Finley III
- Flagship Rehabilitation, Inc
- Nikki Floyd
All providers in Waynesboro, PA · Physician Assistant in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 12, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.